HomeMy WebLinkAbout3105 Regatta Ln - Applications/Reroof - 04/08/2019 (4)FCity of Planning, Development, & Transportation Services
ort Collins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # U \"I oa � 4 l DatLC
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For office use only
Job Site Address (required) �. Value of Construction (labor, materials, prof
Ge�) #� l o9s Co Rnu;z SY
Property Owner a Address City/State Zip Phon
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Applicant Name Address City/State ip Phone 3
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r` tractor Address City/State �� ip Phone3
Contractor City of F�bCollins Sales Tax # Are you paying taxes here4ir by report? Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes to
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Is this a residential or commercial project? Reside tial ❑ Commercial
If residential, is it: ❑ Single Family Deta ed Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ YesXNo Ifyes, you may need to contact Historic preservation
If this is for a demolition permit, what year was the building constructed?
esscri tion of work e
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*If lawn sprinkler/backFlow preventer, must list licensed plumber. I rst-time A/C, must list licensedelectrician.
Subcontractors: List the companynameorCityofFtCollinslicense# A IC�jv yu
Electrician Plumber Mechanical Roofer)��(r Other
I hereby acknowledge that I have read this application and state that the above information is complete an correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it hasbeenpaid and issued.
Applicant: J t [/� as P � v`\
Print Name: /� l Signatu Date
Revision date 2/6/2017
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